Jaw cysts

Author: Mikael Häggström

Microscopic examination

File:Relative incidence of odontogenic cysts.jpg

Relative incidence of odontogenic cysts.

By epidemiology, look for signs of being either a periapical cyst (also called radicular cyst), a dentigerous cyst or a residual cyst:

Cyst type	Lining epithelium	Other characteristics	Image
Periapical (radicular) cyst	Stratified squamous epithelium of variable thickness, except when originating in a maxillary sinus where there is respiratory epithelium (pseudostratified ciliated columnar epithelium).	A fibrous capsule of varying thickness, with chronic inflammatory cells, wherein a plasma cells may be abundant. They sometimes have the following features: Cholesterol clefts in the cyst lining.	File:Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells, and ciliated cells.jpg Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells (B), and ciliated cells (C).
Non-inflamed dentigerous cyst	2 - 4 layers of cuboidal epithelium, devoid of superficial keratinization. Sometimes partially a thin, fragmented layer of eosinophilic columnar cells or low cuboidal epithelium	Typically: Fibrous to fibromyxoid connective tissue No rete ridges, flat interface They occasionally have: Dystrophic calcifications
Inflamed dentigerous cyst	Hyperplastic non-keratinized epithelium	Typically: Fibrous connective tissue Chronic inflammatory cells Sometimes: Elongated interconnecting rete ridges Cholesterol clefts, possibly cholesterol granuloma They occasionally have: Dystrophic calcifications
Residual cyst	Stratified squamous epithelium: May demonstrate exocytosis, spongiosis, and/or hyperplasia May be discontinuous in part and range in thickness from 1 to 50 cell layers, but usually 6 - 20 cell layers In early cysts, the epithelial lining tend to be proliferative and arcading, with an intense inflammation. Established cysts tend to rather have fairly regular lining with a higher degree of differentiation, resembling a simple stratified squamous epithelium	Cyst lumen may demonstrate fluid and cellular debris.

All types above can occasionally have scattered mucous or ciliated cells, as well as Rushton bodies, which are amorphic, eosinophilic, linear to crescent-shaped bodies in the cyst epithelium.

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